Prescription Patterns of New Use of Fixed-Dose Combination Inhalers in Patients with Chronic Obstructive Pulmonary Disease: Long-Acting ß2 Agonists Plus Long-Acting Muscarinic Antagonists versus Long-Acting ß2 Agonists Plus Inhaled Corticosteroids.

Background: The clinical guideline recommends use of long-acting ß2 agonists/long-acting muscarinic antagonists (LABA/LAMA) or long-acting ß2 agonists/inhaled corticosteroids (LABA/ICS) combination therapies for patients with severe chronic obstructive pulmonary disease (COPD). The fixed-dose combination (FDC) inhalers of LABA/LAMA and LABA/ICS were reimbursed in Taiwan in 2015 and in 2002, respectively. This study aimed to examine prescription patterns of new use of either FDC therapy in real-world practice. Methods: We identified COPD patients who initiated LABA/LAMA FDC or LABA/ICS FDC between 2015 and 2018 from a population-based Taiwanese database with 2 million, randomly sampled beneficiaries enrolled in a single-payer health insurance system. We compared number of LABA/LAMA FDC and LABA/ICS FDC initiators in each calendar year, from different hospital accreditation levels, and cared for by different physician specialties. We also compared baseline patient characteristics between LABA/LAMA FDC and LABA/ICS FDC initiators. Results: A total of 12,455 COPD patients who initiated LABA/LAMA FDC (n=4019) or LABA/ICS FDC (n=8436) were included. Number of LABA/LAMA FDC initiators increased apparently (n=336 in 2015 versus n=1436 in 2018), but number of LABA/ICS FDC initiators decreased obviously (n=2416 in 2015 versus n=1793 in 2018) over time. The preference of use of LABA/LAMA FDC varied across clinical environments. The proportions of LABA/LAMA FDC initiators were more than 30% in the setting of non-primary care clinics (eg, medical centers) and in the services of chest physicians; but were only less than 10% in primary care clinics and non-chest physicians' services (eg, family medicine physicians). LABA/LAMA FDC initiators appeared to be older, male, to have more comorbidities, and to utilize resources more frequently compared to LABA/ICS FDC initiators. Conclusion: This real-world study found evident temporal trends, variations in healthcare provider, and differences in patient characteristics among COPD patients who initiated LABA/LAMA FDC or LABA/ICS FDC.

Change in weight status and academic performance among senior high school students in Taiwan.

INTRODUCTION: This study examines how the changes in weight status across the spectrum of a senior high school study are associated with academic performance measured by the university entrance exam scores. MATERIALS AND METHODS: A unique dataset which compiles a national health examination profile and the General Scholastic Ability Test data bank in Taiwan was constructed. The final sample comprised 149,240 senior high school students of which 70,662 were males and 78,578 were female students. The school-level fixed effect models were estimated. RESULTS: Students who were either (a) not overweight in the first year but overweight in the third year of senior high school, (b) overweight in both the first and third year, or (c) overweight in the first year but not overweight in the third year, were more likely to score lower on the university entrance exam, compared with their never-overweight counterparts. The findings differ by gender and test subjects. DISCUSSIONS: The change in weight status during senior high school period is associated with subsequent university entrance exam outcome. Students who start senior high school being overweight should be paid attention. School-based programs and practices need to be implemented to reduce the prevalence of overweight among students.

Examining the relationship between cardiorespiratory fitness and body weight status: empirical evidence from a population-based survey of adults in Taiwan.

BACKGROUND: Cardiovascular disease is the number one cause of death worldwide. Meanwhile, obesity has been recognized as a global epidemic. This study aims to examine the extent to which cardiorespiratory fitness is associated with body mass among adult males and females in Taiwan. MaTERIALS AND METHODS: A nationally representative dataset consisting of 68,175 adults aged 18-60, including 31,743 males and 36,432 females, was used. Several multivariate regression models were used to investigate the relationship between cardiorespiratory fitness and body weight status, after controlling for adults' sociodemographic status. RESULTS: A one-unit increase in the BMI lowered the cardiorespiratory fitness score by 0.316 and 0.368 points for adult males and females, respectively. Among adult males, compared to those of normal weight, adult males who were underweight, overweight, or obese had a lower cardiorespiratory fitness score by 1.287, 0.845, and 3.353 points, respectively. Similar results could be found in female samples. CONCLUSION: The overweight and obese adults had much lower levels of cardiorespiratory fitness as compared to their normal weight counterparts. Given the upward trend in the prevalence of overweight and obesity, it is important to help overweight and obese people to become more fit and reach their healthy weight.

Is tattooing a risk factor for adolescents' criminal behavior? Empirical evidence from an administrative data set of juvenile detainees in Taiwan.

Juvenile crime affects not only the victims of the crime but also the delinquents' future. How to prevent adolescent criminal behavior has become an important public policy issue. This study contributes to this interesting issue by examining the relationship between tattooing and adolescents' criminal behavior. In particular, this study investigates whether or not having a tattoo/tattoos is connected to the incidence of various criminal activities, including: larceny, robbery, fraud, assault, drug use, and homicide. A unique sample of 973 juvenile detainees drawn from the administrative profiles in Taiwan and the coarsened exact matching method were utilized. Results show that compared to their nontattooed counterparts, tattooed juvenile detainees were significantly more likely to commit fraud, assault, drug abuse, and homicide by 3%, 13%, 9%, and 9%, respectively. In contrast, tattooing was not significantly associated with larceny or robbery. From a policy perspective, given the significant link between tattooing and criminal behavior, the presence of a tattoo in adolescents may serve as a valuable indicator regarding adolescents' high probability of committing crimes.

Physical fitness and academic performance: empirical evidence from the National Administrative Senior High School Student Data in Taiwan.

This study examined the relationship between the changes of physical fitness across the 3-year spectrum of senior high school study and academic performance measured by standardized tests in Taiwan. A unique dataset of 149 240 university-bound senior high school students from 2009 to 2011 was constructed by merging two nationwide administrative datasets of physical fitness test performance and the university entrance exam scores. Hierarchical linear regression models were used. All regressions included controls for students' baseline physical fitness status, changes of physical fitness performance over time, age and family economic status. Some notable findings were revealed. An increase of 1 SD on students' overall physical fitness from the first to third school year is associated with an increase in the university entrance exam scores by 0.007 and 0.010 SD for male and female students, respectively. An increase of 1 SD on anaerobic power (flexibility) from the first to third school year is positively associated with an increase in the university entrance exam scores by 0.018 (0.010) SD among female students. We suggest that education and school health policymakers should consider and design policies to improve physical fitness as part of their overall strategy of improving academic performance.

National Health Insurance program and life satisfaction of the elderly.

OBJECTIVES: To ensure people's fundamental right to adequate medical care, universal health insurance is given a high priority in contemporary public policy. This article investigates the effects of the introduction of Taiwan's National Health Insurance (NHI) on life satisfaction within the elderly segment of the population. METHODS: A longitudinal data set including 610 males and 430 females aged 65 or above was constructed from the Survey of Health and Living Status of the Elderly in Taiwan. A difference-in-differences-in-differences model was employed and estimated by the random-effect regression method. RESULTS: The effects of NHI on life satisfaction are different by gender. Compared to the change in life satisfaction between the previously uninsured and insured elderly men, the introduction of NHI had a larger effect of 4.330 points on reducing the disparity in life satisfaction between previously uninsured and insured elderly women. Education, living arrangements, lifestyle, social activities, geographic location, and urbanization level are also important determinants for life satisfaction among the elderly. CONCLUSIONS: Although NHI is designed to ensure equality for accessing health care, the implementation of NHI has also improved the subjective well-being of the elderly, with a larger improvement for the elderly women. The post-NHI disparity reductions in life satisfaction between the previously uninsured and insured are significantly greater among elderly women. Our analysis of Taiwan's experience should provide a valuable lesson to countries that are in the initial stages of proposing a universal health insurance program.

Does the universal health insurance program affect urban-rural differences in health service utilization among the elderly? Evidence from a longitudinal study in taiwan.

PURPOSE: To assess the impact of the introduction of Taiwan's National Health Insurance (NHI) on urban-rural inequality in health service utilization among the elderly. METHODS: A longitudinal data set of 1,504 individuals aged 65 and older was constructed from the Survey of Health and Living Status of the Elderly. A difference-in-differences model was employed and estimated by the random-effect probit method. FINDING: The introduction of universal NHI in Taiwan heterogeneously affected outpatient and inpatient health service utilization among the elderly in urban and rural areas. The introduction of NHI reduced the disparity of outpatient (inpatient) utilization between the previously uninsured and insured older urban residents by 12.9 (22.0) percentage points. However, there was no significant reduction in the utilization disparity between the previously uninsured and insured elderly among rural residents. CONCLUSIONS: Our study on Taiwan's experience should provide a valuable lesson to countries that are in an initial stage of proposing a universal health insurance system. Although NHI is designed to ensure the equitable right to access health care, it may result in differential impacts on health service utilization among the elderly across areas. The rural elderly tend to confront more challenges in accessing health care associated with spatial distance, transportation, social isolation, poverty, and a lack of health care providers, especially medical specialists.

Heterogeneous impact of Taiwan's national health insurance on labor force participation of married women by income and family structures.

In this study, I investigate how the impact of the National Health Insurance (NHI) introduction in Taiwan in 1995 on the labor force participation (LFP) decisions of married women varies with income and family structures. Employing the difference-in-differences (DID) approach, I find that the NHI introduction reduced LFP of married women in the twenty-fifth to fiftieth percentiles of the income distribution between 17.8 and 21.7 percentage points (33%-40%). The difference-in-differences-in-differences (DIDID) results suggest that married women in different family structures (the presence of children under 3 or less healthy elderly household members) did not respond differently to the NHI introduction.